Characteristics and outcomes of patients with atrial versus ventricular secondary tricuspid regurgitation undergoing tricuspid transcatheter edge-to-edge repair - Results from TriValve Registry.

Russo, Giulio; Badano, Luigi P; Adamo, Marianna; Alessandrini, Hannes; Andreas, Martin; Braun, Daniel; Connelly, Kim A; Denti, Paolo; Estevez-Loureiro, Rodrigo; Fam, Neil; Gavazzoni, Mara; Hahn, Rebecca T; Harr, Claudia; Hausleiter, Joerg; Himbert, Dominique; Kalbacher, Daniel; Ho, Edwin; Latib, Azeem; Lubos, Edith; Ludwig, Sebastian; ... (2023). Characteristics and outcomes of patients with atrial versus ventricular secondary tricuspid regurgitation undergoing tricuspid transcatheter edge-to-edge repair - Results from TriValve Registry. European journal of heart failure, 25(12), pp. 2243-2251. Oxford University Press 10.1002/ejhf.3075

Text European_J_of_Heart_Fail_-_2023_-_Russo_-_Characteristics_and_outcomes_of_patients_with_atrial_versus_ventricular_secondary.pdf - Accepted Version Restricted to registered users only until 31 October 2024. Available under License Publisher holds Copyright. Download (2MB)

BACKGROUND

Secondary or functional tricuspid regurgitation (STR) is the most common phenotype of tricuspid regurgitation (TR) with atrial STR (ASTR) and ventricular STR (VSTR) being recently identified as two distinct entities. Data on tricuspid transcatheter edge-to-edge repair (T-TEER) in patients with STR according to phenotype (i.e. ASTR vs VSTR) are lacking.

OBJECTIVES

The aim of this study was to assess characteristics and outcomes of patients with ASTR vs VSTR undergoing T-TEER.

METHODS

Patients with STR undergoing T-TEER were selected from the TriValve (Transcatheter Tricuspid Valve Therapies) registry. ASTR was defined by 1) left ventricular ejection fraction ≥50%; 2) atrial fibrillation and 3) systolic pulmonary arterial pressure < 50 mmHg. Patients not matching these criteria were classified as VSTR. Patients with primary TR and cardiac implantable electronic device were excluded. Key end-points included procedural success and survival at follow-up.

RESULTS

Two-hundred-ninety-eight patients were enrolled in the study: 65 (22%) with ASTR and 233 (78%) with VSTR. Procedural success was similar in the two groups (80% vs 83% for ASTR and VSTR, respectively, p = 0.56) and TEER was effective in reducing TR in both groups (from 97% of patients with baseline TR ≥3+ to 23% in ASTR and to 15% in VSTR, all p = 0.001). At 12 months follow-up, survival was significantly higher in ASTR vs VSTR cohort (91% vs 72%, log rank p = 0.02), with VSTR being an independent predictor of mortality at multivariable analysis (hazard ratio 4.75).

CONCLUSIONS

In a real-world, multicenter registry, T-TEER was effective in reducing TR grade in both ASTR and VSTR. At 12-months follow-up, ASTR showed better survival than VSTR. This article is protected by copyright. All rights reserved.

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